Acute pulmonary heart failure. Cardiopulmonary failure: causes, main symptoms, diagnosis Drugs for cardiopulmonary failure

Cardiopulmonary failure- a clinical syndrome characterized by a combination of heart failure and associated pulmonary insufficiency. The development of pulmonary insufficiency (more often with heart defects and myocarditis) is due to impaired blood circulation in the vessels of the lungs (stagnation, increased

blood pressure. inclusion of anastomoses), which leads to a decrease in blood oxygen saturation.

In medical practice, chronic pulmonary heart failure is more common - a combination of pulmonary and associated heart failure. It is observed with the so-called. cor pulmonale in patients with chronic lung diseases (see Pneumosclerosis). The causes of the development of heart (right ventricular) insufficiency are hypertension of the pulmonary circulation (systolic pressure in the pulmonary artery exceeds 30 mm Hg and diastolic pressure is above 15 mm Hg), hypoxia, acidosis, a decrease in the pulmonary vasculature, bronchial infection, polyglobulia . The first clinical manifestation is shortness of breath on exertion; later it becomes constant.

A decrease in arterial oxygen saturation (90% or less) leads to the appearance of cyanosis (cyanosis). Signs of right ventricular insufficiency join. A frequent increase in the content of erythrocytes and hemoglobin in the blood is a manifestation of the compensatory reaction of the body to a decrease in the concentration of oxygen in arterial blood. To diagnose cardiopulmonary insufficiency, X-ray examination, electrokymography, electrocardiography, catheterization of the right cavities of the heart and pulmonary artery, and other research methods are used.

Treatment of pulmonary heart disease and cardiopulmonary insufficiency includes the therapy of a lung or heart disease that caused the development of the syndrome, the use of cardiac glycosides, aminophylline, diuretics, restoratives, and in some cases repeated bloodletting.

(Lit. Mukharlyamov N. M. Pulmonary heart. M. 1973; Sivkov I. I. Kukes V. G. Chronic circulatory failure, M. 1973. N. R. Paleva.)

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Cardiopulmonary failure: causes, symptoms, diagnosis and treatment

The term cardiopulmonary insufficiency is understood as a combined disruption of the respiratory and vascular systems. The basis of this pathological process is an increase in pressure in the vascular system of the small circle, which is responsible for gas exchange between the blood and the environment.

According to its clinical course, this condition can be acute, when symptoms appear and increase over a short time period, or chronic, in which the signs become noticeable only after a few years.

The reasons

Acute cardiopulmonary failure is usually the result of an emergency situation and requires immediate medical attention.

• her thrombosis or spasm;
• thromboembolism from the veins or cavity of the heart;
• exacerbation of bronchial asthma or status asthmaticus;
• sharply developed total pneumonia;
• pneumothorax or hydrothorax (usually hemothrax), which in most cases are the result of trauma.

In addition to pathological changes in the respiratory system, the root cause of pulmonary hypertension may be associated with a malfunction of the heart muscle.

Most often, sudden severe mitral valve insufficiency leads to such changes. Usually there is a rupture of the papillary muscles as a result of acute myocardial ischemia or infarction. Traumatic injury is also possible. Another cause may be prosthetic valve dysfunction, which is usually associated with thrombosis and infection.

In chronic pulmonary heart failure, there is a gradual increase in pathological changes in the respiratory system. Its causes are usually associated with the following diseases:

With acquired valvular disorders, the pressure also usually rises gradually. The same can be said about unexpressed slowly progressive congenital conditions.

Symptoms

Symptoms of acute cardiopulmonary insufficiency are usually more pronounced than in its chronic course. These include:

• shortness of breath (shallow breathing, its frequency reaches 40 per minute and above);
• feeling of lack of oxygen, reaching suffocation;
• cyanosis due to hypoxia and venous congestion;
• cold or sticky sweat due to centralization of blood circulation;
• collapse resulting from a sudden decrease in systemic pressure;
• pain in the sternum, which is associated with ischemia and a change in the size of the heart.

Chronic pulmonary heart failure has less pronounced clinical signs, which are associated with the gradual development of hypertension in the vessels of the small circle.

In the early stages, there are usually no symptoms, as changes are compensated for by left ventricular hypertrophy. In the future, they begin to appear only during periods of pronounced activity.

At the final stage, the manifestations of the disease are noticeable even in a state of complete rest.

Since the cause of chronic cardiopulmonary insufficiency is often the pathology of the respiratory system, shortness of breath is mandatory. Other manifestations are listed below:

The last two signs appear with secondary changes occurring in the heart under the influence of the underlying disease.

Diagnostics

Diagnosis of this condition begins with examining the patient and asking about his health and complaints. For a more detailed assessment, an instrumental examination is carried out:

• x-ray of the lungs, which reveals both diseases of the respiratory system and changes in the size of the heart;
• Chest CT is performed if necessary, if the diagnosis remains doubtful after x-ray;
• Ultrasound of the heart allows you to establish the degree of disruption of the work of this organ;
• catheterization and invasive manometry with high accuracy determines the pressure in the pulmonary artery and heart cavities;
• The ECG reflects secondary changes in advanced cases.

Treatment

In an acute condition, treatment should be carried out in a hospital, more often in intensive care. The patient should remain calm and breathe an oxygen-enriched mixture. This is usually done using humidified gas supplied through nasal prongs or a face mask. In severe cases, tracheal intubation and artificial ventilation of the lungs are performed.

The drugs are usually administered intravenously:

• papaverine dilates blood vessels and reduces the severity of hypertension;
• aminophylline helps to stabilize heart contractions and reduce the degree of respiratory failure;
• atropine is administered to expand the bronchi by relaxing their smooth muscle cells;
• anticoagulants are effective in the presence of thrombosis;

In the case of proven pulmonary embolism, thrombolysis is performed using actilyse or streptokinase. These drugs dissolve the formed thrombotic masses and normalize blood flow. If you spend it in the first hours after the onset of the disease, then the chances of a full recovery are quite high.

Sometimes surgery is performed, but the severity of the patient's condition does not always allow the operation to be performed. In the presence of foreign objects in the pulmonary artery, they can be removed using a minimally invasive technique. In this case, the doctor works with catheters that are inserted through the femoral or radial artery.

In the case of a chronic course of pulmonary heart failure, treatment should be directed to the elimination of the underlying primary disease. For example, antibiotics are used for inflammatory changes, and hormones and other bronchodilators are used for bronchospasm.

In addition, all classes of drugs that are prescribed for heart failure (diuretics, ACE inhibitors, etc.) are used. Caution requires the use of beta-blockers, as they usually worsen the course of pulmonary pathology by reducing the diameter of the bronchial lumen.

With low pressure and respiratory depression, you can use drugs (caffeine, camphor) that stimulate the vasomotor center, which is located in the brain. Usually this happens in the terminal stage of the disease, and such drugs serve rather as a measure of desperation.

An important role in the rehabilitation process is played by constant maintenance therapy, adherence to a protective regimen and proper diet. It is also necessary to give up bad habits that can aggravate the course of the disease, such as smoking. All this allows to increase survival and reduce the manifestations of insufficiency.

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Symptoms and treatment of cardiopulmonary insufficiency

Cardiopulmonary failure is a disease that combines a decrease in the contractile function of the heart muscle and the inability of the respiratory system to provide the blood vessels with the necessary oxygen.

Cardiopulmonary failure is a disease that combines a decrease in the contractile function of the heart muscle and the inability of the respiratory system to provide the blood vessels with the necessary amount of oxygen. This disease is both acute and chronic and entails a significant decrease in the quality of human life.

It is noteworthy that the causes of such a condition as pulmonary heart failure can be associated with both individual and joint disorders in the work of the heart and lungs.

Causes

The main causes of the disease are as follows:

• cardiac asthma and pulmonary edema;
• pneumosclerosis;
• pulmonary vasculitis;
• emphysema;
• thromboembolism;
• bronchial asthma or COPD;
• stenosis of the pulmonary artery.

Also, a similar disease can occur with deformation of the chest or ordinary scoliosis.

Symptoms

Insufficiency of cardiopulmonary origin has pronounced symptoms that cannot be overlooked.

1. Symptoms of shortness of breath appear already at the initial stage of the disease. In most cases, shortness of breath occurs with any physical exertion.
2. Symptoms of cyanosis (cyanosis) also become noticeable immediately. This is due to a lack of oxygen in the arterial blood. Because of this, in a sick person, the skin becomes ash-gray.
3. Symptoms of a compensatory reaction occur after the onset of cyanosis. Blood deprived of the necessary oxygen begins increased production of hemoglobin and red blood cells. Therefore, when taking tests, the patient has increased these blood components.
4. Symptoms of pain in the right hypochondrium also indicate insufficiency of the cardiopulmonary nature, as this is a sign of insufficiency of the right heart.
5. Symptoms of sudden hypotension can also be signs of this disease. Sometimes a person feels a sharp weakness and headache, darkening in the eyes.

Sometimes the symptoms described above can be signs of another disease.

Diagnostics

In order to identify the presence of heart failure in a person and choose the necessary treatment, it is necessary to conduct certain studies. This disease is detected using several types of instrumental research.

Radiography of the heart and lungs

X-ray shows changes in the size and shape of the shadow of the heart, as well as its ventricles. There are typical radiological signs of cardiopulmonary insufficiency. One of the indicators in this examination is the presence of fluid in the pleura and changes in the shadows of the pulmonary veins. If they are enlarged, then there is edema - accordingly, a disease.

echocardiography

Echocardiography is an important ultrasound method for studying the state of all parts of the heart, the valvular apparatus, as well as myocardial contractility, the speed and volume of blood that is ejected from the atria of the heart into the ventricles and further into the aorta and pulmonary artery. There are strict criteria that indicate the presence or absence of right or left ventricular heart failure.

Electrocardiography

Electrocardiography shows the electrical fields generated by the heart. Incorrect work of any part of the heart, rhythm disturbances, ischemia and hypertrophy are clearly visible on a conventional ECG. Sometimes long-term ECG research methods are used, such as Holter monitoring and stress testing - Bicycle ergometry. Cardiac arrhythmias often cause insufficiency of cardiopulmonary insufficiency.

Electrokymography

Electrokymography reveals possible changes in the cardiovascular system, in particular, violations of the movements of the heart.

Cardiac catheterization

Catheterization of the pulmonary artery and right cavities of the heart determines the blood pressure in these organs and thereby reveals a possible disease.

Methods of treatment

Currently, the treatment of cardiopulmonary insufficiency is carried out:

• diuretic drugs;
• cardiac glycosides
• beta blockers;
• surgical intervention;
• bloodletting;
• folk medicine.

Diuretic drugs

Treatment with diuretics helps to eliminate excess fluid that accumulates in the body, as a result of a decrease in the contractility of the heart. Hydrochlorothiazide is an effective and inexpensive diuretic. It stabilizes pressure and removes excess fluid.

An immediate and stronger drug is furosemide. It is usually taken in the morning on an empty stomach with regular monitoring of the electrolyte-salt balance. Since important trace elements are excreted from the body along with the liquid. The effect of the drug lasts 6 hours. It is possible to use it even with weak kidney function. Furosemide helps to quickly remove puffiness and removes excess fluid well. Another effective diuretic drug, thanks to which you can get rid of edema and remove excess fluid, is ethacrynic acid.

Beta blockers

Treatment of the disease with beta-blockers improves the functioning of the left ventricle of the heart, normalizes blood circulation, and helps relieve swelling.

The most effective beta-blockers are propranolol and timolol. They have adreno-selective properties and eliminate almost all the symptoms of this disease. Treatment with metoprolol is also considered effective. Since it has maximum cardioselectivity and eliminates all signs of the disease.

Surgical intervention

Cardinal treatment is applicable if the disease is severe. The most commonly used atrial septostomy, thromboendarterectomy or organ transplantation.

An atrial septomy is necessary to reduce pressure in the right atrium and pulmonary artery. A thromboendarterectomy is used to remove blood clots from the lungs. Transplantation is used if other methods of treatment have not given the desired effect.

bloodletting

This treatment consists in removing a certain amount of blood from the bloodstream. Up to 400 ml of blood is emitted from the body of the sufferer. With this method of salvation from the disease, the patient's pressure decreases, excess fluid is eliminated, and swelling disappears.

Glycosides

The most effective glycoside that is common in Russia is digoxin. Glycosides are positive inotropic agents that improve the quality of life of patients suffering from pulmonary heart failure.

Glycosides are prescribed in small doses. Using cardiac glycosides, patients are less likely to seek hospitalization.

Folk remedies

Treatment with folk remedies should be carried out only after consultation and doctor's prescriptions. Because this disease is very serious and dangerous.

The main remedy for this disease is a simple wormwood. It normalizes blood circulation, eliminates pain, removes excess fluid. From wormwood you need to prepare a decoction and take it before meals every day for three quarters of a glass.

Another no less effective remedy is a decoction of nettle. This decoction should be used to make hand baths. Timed treatment lasts 10 minutes every day

Pumpkin juice is also an excellent remedy for this disease.

It must always be remembered that folk recipes alone are indispensable in the treatment of diseases of the heart and lungs, moreover, some drugs cannot be used simultaneously with herbal preparations due to the possible increase in side effects.

Often we hear the expression "cardiopulmonary failure", but few can definitely say what this pathology is. What kind of disease is this, what are its signs and causes - we will understand.

Cardiopulmonary failure - what is it?

In modern medicine, cardiopulmonary insufficiency is understood as a condition in which heart failure, that is, the inability of the heart to provide normal blood supply in the body, is combined with pulmonary, which occurs due to blood in the vessels of the lungs, where gas exchange occurs. All this leads to a decrease in the level of oxygen in the blood.

In practice, more often pulmonary insufficiency develops first, the symptoms of cardiac insufficiency join it after a while. Strictly speaking, this symptom complex can be observed both in many diseases of the cardiovascular system and in diseases of the lungs. In its course, the pathology can manifest itself in an acute form, when the symptoms increase in a short time period, and it can also have a chronic variety, when the condition worsens over several years or even decades.

Causes of acute cardiopulmonary failure

Acute pulmonary insufficiency is a complication that occurs in some conditions that threaten the life of the patient. This requires urgent medical intervention. As a rule, it can develop under the following conditions:

• as a consequence of thrombosis or spasm of the pulmonary artery;
• with thromboembolism;
• with pneumo- or hydrotorex;
• with exacerbation of bronchial asthma, status asthmaticus.

However, cardiac pathologies can also cause an increase in pressure in the pulmonary artery. Most often, this occurs with sudden mitral valve insufficiency. Also, the cause of the development of pulmonary insufficiency can be pulmonary valve insufficiency, acute heart attack, myocarditis, in the stage of decompensation, cardiomyopathy. At the same time, the cavity of the left ventricle expands, and the contraction of its wall is no longer able to push the entire volume of blood into the lumen of the vessel. Some of it stagnates and increases the pressure in the pulmonary veins. As the right ventricle continues to pump blood to its full capacity, the pressure continues to rise, which can lead to or cardiac asthma.

Causes of chronic cardiopulmonary insufficiency

Chronic pulmonary insufficiency, in contrast to the acute form, grows slowly. The process of increasing pathological changes goes on for several years. In this case, the development of hypertension in the pulmonary vessels occurs in connection with the following pathologies:

• hereditary idiopathic hypertension;
• atherosclerosis;
• insufficiency of the pulmonary artery, which can be caused by endarteritis or repeated embolism of small branches;
• chronic lung diseases - emphysema, pleurisy, pneumosclerosis, obstructive bronchitis;
• slowly progressive;
• acquired valvular disorders.

Pulmonary insufficiency: severity

Due to the fact that the chronic form of this disease is characterized by a slow and often almost imperceptible increase in pathological symptoms, four degrees of severity of the disease are determined:

• I degree - there are no signs of the disease, with the usual physical activity, the manifestations of the disease are not observed, with an increase in the load, a slight shortness of breath appears.
• Grade II - no symptoms at rest, but shortness of breath and palpitations appear with habitual physical exertion.
• III degree - symptoms of insufficiency appear with minimal physical exertion, but are absent at rest.
• IV degree - a person cannot exercise minimal physical activity, signs of the disease appear at rest.

An acute attack of pulmonary insufficiency can develop according to one of two options - right and left ventricular failure. may present with pulmonary edema or cardiac asthma.

cardiac asthma

This is a pulmonary insufficiency, the symptoms of which increase gradually. In the early stages, it is manifested by shortness of breath, which appears first after physical exertion, over time it intensifies, appearing even at rest. With shortness of breath, the act of inhalation (inspiratory character) is difficult. In the future, it is replaced by asthma attacks, most often occurring during sleep. For this stage, a forced posture is indicative - a high headboard, during attacks the patient is forced to sit down, lowering his legs from the bed and leaning on his hands, in addition to shortness of breath, palpitations, sweating, and fear of death appear. The cough in cardiac asthma is dry, with scanty expectoration. The skin is pale, pronounced cyanosis of the fingers. The pulse is irregular, weak, the pressure is reduced.

Consider what features of cardiac and bronchial asthma have:

Pulmonary edema

Acute pulmonary insufficiency may be complicated by the development of pulmonary edema. This is the release of a significant amount of blood into the lung tissue. The attack develops suddenly, regardless of the time of day. The onset is characterized by a sharp suffocation, while there is a rapid deterioration in the patient's condition:

• shortness of breath intensifies, the patient does not have enough air, cyanosis of the skin of the face and extremities is noted, cold sweat;
• consciousness is disturbed - it can be both motor excitement and stupor up to complete loss of consciousness;
• breathing is noisy, bubbling, pink foam stands out;
• if the attack occurred on the background of myocardial infarction or myocarditis, cardiogenic shock may develop.

Right ventricular failure

It can also occur as a complication of myocardial infarction or myocarditis. Its manifestations, in addition to shortness of breath and increasing suffocation, are:

• cyanosis of the face and fingers;
• clearly visible, especially on inspiration, swollen jugular veins;
• swelling of the legs, face, abdominal wall up to ascites;
• an increase in the liver, there is a pulsation in the epigastrium.

Chronic cardiopulmonary failure

Due to the fact that the chronic form of this pathology develops over many years, its clinical manifestations are less pronounced. Since the disease is most often based on pathologies of the respiratory system, it manifests itself primarily in shortness of breath. It may be accompanied by the following symptoms:

• chest pain;
• arrhythmia;
• tachycardia;
• cyanosis;
• swelling in the legs;
• swelling of the veins of the neck;
• encephalopathy.

As the disease progresses, the symptoms begin to intensify, and if at first they appeared after certain loads, then in the final stages (in the stage of decompensation) this occurs in complete rest.

Cardiopulmonary failure: treatment

The development of acute insufficiency usually requires prompt and professional intervention. As a rule, treatment is carried out in a hospital, and more often in an intensive care unit. If the attack has developed at home, you need to deliver the person to a medical facility as soon as possible. Therapy of the chronic form of the disease is an integrated approach to the treatment of the disease. This is not only a medical correction, but also an optimization of the level of physical activity and nutrition. Drug therapy for this pathology consists in prescribing the following groups of drugs:

• beta blockers;
• diuretics;
• cardiac glycosides.

The scheme of therapy and dosage in each case is determined by the doctor. Self-medication in such cases is unacceptable. In case of ineffectiveness of conservative treatment, the problem is solved surgically.

Cardiopulmonary failure is a pathology of the respiratory and cardiovascular systems, progressing due to an increase in pressure in the pulmonary circulation. As a result, the right ventricle of the heart begins to function more intensively. If the disease progresses over a long period of time and it is not treated, then the muscle structures of the right heart will gradually increase their mass (due to increased work).

Clinicians call this period compensated - complications, as a rule, do not occur. With further progression of pulmonary heart failure, the compensatory mechanisms of the body break down, and a decompensated period sets in (changes in the heart muscle are irreversible).

Etiology

Bronchogenic, vascular and thoracophrenic factors can provoke cardiopulmonary insufficiency.

Vascular etiological factors:

• pulmonary;
• benign or malignant mediastinal tumor;
• aneurysm.

Thoracodiaphragmatic:

Bronchogenic factors:

• with a chronic course;
• bronchiectasis;
• extensive;
• emphysematous changes in lung tissues;

Symptoms

Symptoms of the disease depend on the form in which it proceeds - in acute or in chronic. It is worth noting that the acute form is a more serious condition requiring immediate ambulance.

acute form

In the case of an acute form of the disease, the symptoms appear and develop very quickly. This type of failure occurs in the following cases:

• or spasm of the trunk of the pulmonary artery;
• sternum injury of varying severity;
• damage to most of the lungs by an inflammatory process.

Acute symptoms:

• acute pain in the sternum;
• breathing becomes frequent and superficial;
• legs and arms get cold;
• decrease in blood pressure. Even possible;
• a characteristic symptom is shortness of breath (difficulty inhaling);
• veins in the neck swell;
• increased sweating;
• cyanosis;
• the patient is out of breath. Perhaps even suffocation.

Chronic form

Symptoms of the chronic form directly depend on the stage of development of the pathological process. If there is a compensated stage, then the patient has symptoms of an ailment that provoked the progression of insufficiency. Chronic insufficiency develops over a long period of time.

Symptoms of pathology:

• increased heartbeat;
• with physical shortness of breath appears on the load;
• in the epigastrium, a person can feel a pulsation;
• dizziness;
• increased fatigue;
• acrocyanosis.

In the case of progression of the decompensated stage, the symptoms also appear gradually, but they lead to destructive changes in tissues and vital organs. Symptoms of the stage of decompensation of the chronic form of the disease:

• edema. It is noteworthy that they are very resistant to treatment;
• acrocyanosis;
• in the area of ​​the projection of the heart, ischemic pain is noted;
• BP goes down;
• veins in the neck swell;
• shortness of breath manifests itself even in a state of complete rest. It tends to increase with a change in position (especially increases in the supine position);

Diagnostics

If one or more of the above symptoms appear at once, you should contact a medical institution as soon as possible for a full diagnosis. The standard plan of diagnostic measures is as follows:

• collection of a detailed anamnesis of life and disease;
• auscultation of the heart;
• measurement of blood pressure;
• angiography of the vessels of the lungs;
• spirometry;
• echocardiography;
• x-ray;

Therapeutic measures

In the case of progression of the acute form, treatment is carried out only in intensive care. Be sure to resort to oxygen therapy. In severe clinical situations, they resort to mechanical ventilation. The following pharmaceuticals are injected into a vein:

• eufillin;
• atropine;
• papaverine;
• anticoagulants;
• thrombolysis drugs.

In the chronic form of pathology, treatment is primarily aimed at eliminating the underlying pathology. The treatment plan includes hormones, anti-inflammatory drugs, and bronchodilators. If there is a pathology of the cardiovascular system, then the following pharmaceuticals are used for treatment:

• cardiac glycosides;
• magnesium and potassium preparations. They are prescribed to improve metabolism in the cells of damaged tissues;
• potassium-sparing diuretics. They are necessarily included in the treatment plan, since they remove excess fluid from the patient's body;
• selective beta-blockers;
• cardioprotectors.

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Diseases with similar symptoms:

Heart defects are anomalies and deformations of individual functional parts of the heart: valves, septa, openings between vessels and chambers. Due to their improper functioning, blood circulation is disturbed, and the heart ceases to fully fulfill its main function - supplying oxygen to all organs and tissues.

Heart failure defines such a clinical syndrome, within the framework of the manifestation of which there is a violation of the pumping function inherent in the heart. Heart failure, the symptoms of which can manifest themselves in a variety of ways, is also characterized by the fact that it is characterized by constant progression, against which patients gradually lose adequate ability to work, and also face a significant deterioration in their quality of life.

Pulmonary insufficiency is a pathology in which the lungs do not enrich the blood with oxygen in the required amount.

This state is characterized by the fact that the pressure of oxygen does not exceed 80, and carbon dioxide is more than 45 mm Hg.

With pulmonary insufficiency, the body is not able to maintain the optimal ratio of gases in the blood.

Disease classification

Depending on the mechanism of development, 3 forms of pulmonary insufficiency are distinguished:

• Hypoxemic;
• Hypercapnic;
• Mixed.

In the hypoxemic form, there is a lack of oxygen in the tissues. It is difficult to bring the condition back to normal even with the help of oxygen therapy. This type of pathology is typical for lesions of the respiratory system and those pathologies in which the lung tissue is replaced by connective tissue.

The alveoli, the peripheral nerve system responsible for the coordinated work of the respiratory organs, the muscles involved in breathing, the central nervous system, the chest, and the respiratory tract are affected.

In hypercapnic form, carbon dioxide accumulates in the tissues. This type of disease is also characterized by a lack of oxygen.

It is possible to normalize the condition with the help of oxygen therapy.

The disease develops against the background of weakness of the muscles that regulate the work of the respiratory system, obesity, chronic obstructive pulmonary disease.

The mixed form is characterized simultaneous combination of hypoxemia and primary hypercapnia.

According to the rate of progression, the forms are distinguished:

• acute
• Chronic

Symptoms of the acute form of the disease manifest themselves in a few minutes or hours, less often - several days. During this period, the compensatory abilities of the body do not have time to turn on.

This is a rather dangerous pathology that threatens life. It is possible to normalize the condition only with the help of intensive care in intensive care.

The chronic form of the disease develops slowly. Pathology can progress without threatening the patient's life for many months or years.

During the specified time, the body manages to turn on the mechanisms of adaptation and provides the optimal gas composition of the blood. This type is considered safe, because it can be identified in a timely manner and normalize the patient's condition.

Specialists distinguish 3 degrees of pulmonary insufficiency, which occurs in a chronic form:

Depending on the severity of the pathology, 3 stages of the disease are distinguished:

• I (light) stage: the partial pressure of oxygen is in the range of 60-80 mm Hg, the blood is saturated with oxygen at the level of 90-94%;
• II stage: partial oxygen pressure drops to 40-59 mm Hg, oxygen concentration in the blood varies within 75-89%;
• III stage: the state is critical, the oxygen pressure becomes less than 40 mm Hg, the oxygen concentration in the blood drops to a level of less than 75%.

With the development of pulmonary insufficiency, it is necessary to understand the causes of its occurrence. Further treatment will depend on this.

Separately, pulmonary heart failure is distinguished. This disease is associated with disruption of the heart, blood vessels and respiratory organs. In some patients, failure develops against the background of regurgitation - throwing part of the blood back into the right atrium.

With this pathology, the blood in full does not enter the respiratory organs. Pulmonary regurgitation of the 1st degree is considered not dangerous, the stream of thrown blood is practically not visible. At grade 4, only surgical intervention allows the patient to remain healthy.

Disease development factors

The causes of pulmonary insufficiency depend on the form of the lesion. The hypoxemic type develops when blood circulation fails in the lungs.

This occurs due to the fact that there is a full exchange of gases between the blood and the alveoli, but the process of gas exchange between the alveoli and the environment is disturbed.

During shunting, the blood from the veins is not saturated with oxygen, it immediately passes into the arteries.

Hypercapnic form develops due to alveolar hypoventilation and violations of ventilation-perfusion mechanisms (the alveoli are not sufficiently ventilated).

The hypercapnic form most often develops against the background of bronchial asthma, prolonged bronchitis, bronchial tumors, bronchopneumonia.

Severe lesions of the lung parenchyma lead to the hypoxemic form.(fluid aspiration, pulmonary edema, inhalation of toxic gases).

Mixed form appears with lung lesions, which provoke hypoventilation of the obstructive type (pneumonia, abscesses, bronchial asthma, obstructive pulmonary emphysema, bronchitis).

The cause of cardiopulmonary failure is considered to be an increase in pressure in the pulmonary circulation (it is responsible for how the process of filling the blood with oxygen occurs).

Hypertension provokes an increase in the activity of the right ventricle and an increase in the intensity of the ejection of blood entering the pulmonary artery. As a result, the myocardium hypertrophies.

All causes of insufficiency are divided into groups depending on which system of the body failed.

1. Neuromuscular system. Pulmonary insufficiency develops and progresses against the background of infectious and neurological lesions that negatively affect the central nervous system, disrupt the transmission of impulses from the brain to the respiratory muscles. It is observed with botulism, myasthenia gravis.
2. Respiratory center and central nervous system. The progression of the disease leads to damage to the brain tissues that have developed against the background of failures of cerebral circulation, the use of drugs.
3. Rib cage. With scoliosis, accumulation of exudate in the pleural cavity, pneumothorax, these problems appear.
4. Oxygen delivery routes. The lesion develops with chronic obstructive pulmonary disease, laryngeal edema, the appearance of embolism in the bronchi.
5. Alveoli. Problems begin with pulmonary edema, pneumonia and other diseases that lead to the growth of connective tissue in the lungs.

The main causes of heart and lung failure include the following:

• Bronchiolitis and bronchitis in a chronic form;
• extensive pneumonia;
• Bronchial asthma;
• Tuberculosis;
• pneumosclerosis;
• emphysema;
• Sarcoidosis;
• bronchiectasis disease.

These are the most common bronchopulmonary factors. But vascular and thoraphragmatic factors can lead to the above problems.

Among them:

• Tumors of the mediastinum;
• Atherosclerotic changes in the pulmonary trunk;
• Inflammatory lung disease (vasculitis);
• Polio;
• Thrombosis of the artery going to the lungs;
• Bechterew's disease;
• Compression of the right side of the heart by a growing aneurysm;
• Kyphoscoliosis;
• Incorrect innervation of the diaphragm.

The characteristic symptoms indicate the appearance of problems. If you know them, you can have time to seek medical help even with an acute form of the disease.

The main signs of the disease

To understand that pulmonary insufficiency develops, it will turn out if you know what kind of disease it is and how it manifests itself.

The main symptoms of the disease include:

• Shortness of breath (regardless of its intensity);
• Headaches that disturb patients mainly in the morning;
• Increased frequency of contractions of the heart muscle;
• insomnia;
• Reducing the level of pressure;
• Vomiting, nausea;
• Blueness of the skin;
• memory problems;
• Changes in breathing (the depth and frequency of inhalations / exhalations changes);
• Participation of auxiliary muscles in the process of breathing.

Patients complain of suffocation, severe shortness of breath. Problems with consciousness and memory are caused by a lack of oxygen in the bloodstream and the accumulation of carbon dioxide in excessive amounts. In severe cases, this causes loss of consciousness or the appearance of a coma.

The most dangerous sign is a drop in respiratory rate: if the patient takes less than 12 breaths per minute, then this indicates the beginning of the process of stopping breathing.

When such signs appear, it is necessary to understand how the disease is diagnosed and treated.

To determine the cause of the above symptoms, it is required:

If signs of pulmonary insufficiency appear, the patient is sent to a medical facility for inpatient treatment.

The choice of treatment tactics

In 30% of cases, patients are admitted to the hospital with acute pulmonary insufficiency.

Save the life of the patient can only timely rendered competent first aid.

It should be aimed at normalizing the airway patency, eliminating hemodynamic disorders and restoring perfusion and lung ventilation.

Information about methods of emergency assistance is given in the table.

With the normalization of pulmonary ventilation, treatment continues. If necessary, continue to supply humidified oxygen: do it with a nasal catheter, through an oxygen mask or tent.

If the problems were caused by bronchospasm, then glucocorticosteroids and bronchodilators are prescribed.

The method of therapy is chosen by the doctor: inhalation or systemic administration of these drugs is possible. Simultaneously prescribed drug therapy.

If the pathology is accompanied by painful sensations, then analgesics are given. To stimulate the work of the heart, blood vessels, cardiac glycosides are prescribed, respiratory organs - respiratory analeptics. Eliminate signs of intoxication and hypovolemia allows infusion therapy.

It is difficult to avoid the negative consequences of the onset of acute respiratory failure. But with timely medical care, a favorable prognosis is possible.

When restoring the work of the respiratory system, it is required to carry out simultaneous treatment of the underlying disease, which provoked the development of pulmonary insufficiency.

Video: Pulmonary hypertension. Why is it difficult for the lungs to breathe?

Many of us have heard such a diagnosis as cardiopulmonary insufficiency (SLN), however, not everyone is familiar with its etiology, causes and consequences. This pathological process provokes failures of the respiratory rhythm and disorders in the cardiovascular system.

The main cause is hypertension, which develops in the pulmonary circulation. The disease is characterized by the release of blood into the pulmonary artery, which is a rather serious problem.

About what cardiopulmonary insufficiency has symptoms and treatment of pathology, we will tell in our dedicated edition.

Cardiopulmonary insufficiency is a pathological process caused by a combination of cardiac and pulmonary insufficiency. Pulmonary insufficiency develops, as a rule, with heart defects and myocarditis, characterized by circulatory failures in the pulmonary vessels.

With a pathological mechanism, the risk of blood stagnation increases, pressure increases, anastomoses are included. All these factors lead to oxygen starvation of the blood.

The disease is inherent in the elderly age category, occurs in two forms:

• acute;
• chronic.

According to ICD-10, pathology code 127.9 "Cardiopulmonary failure of an unspecified type" was assigned.

The disease is a consequence of such concomitant diseases:

• atherosclerosis;
• rheumatism;
• pulmonary pathologies;
• chronic heart disease.

As practice shows, patients who are diagnosed with a chronic form of the disease often turn to the clinic. The very first symptom indicating the development of the disease is shortness of breath, which at the initial stages appears with various physical exertion. Subsequently, shortness of breath becomes a constant accompanying symptom of such patients.

Classification

In medical practice, taking into account the mechanism of occurrence, 3 types of pulmonary insufficiency are distinguished:

1. Hypoxemic.
2. Hypercapnic.
3. Mixed.

Table number 1. Types of pulmonary insufficiency:

According to the rate of development of symptoms, acute and chronic forms are distinguished.

Table number 2. Forms of cardiopulmonary insufficiency:

Such a pathology as cardiopulmonary insufficiency has 3 degrees of flow.

Table number 3. Degrees of the course of cardiopulmonary insufficiency:

In medicine, the classification of the pathological process is also used depending on:

• degree of pulmonary insufficiency;
• an increase in the size of the right ventricle;
• blood oxygen saturation;
• circulatory failure.

In this context, the disease is divided into 4 stages.

Table number 4. Stages of the course of pulmonary insufficiency:

In order for the doctor to prescribe adequate and effective treatment, it is necessary to find out the cause of cardiopulmonary insufficiency. Therapy of pathology is aimed at eliminating the cause and restoring the lost functions of the body.

Attention. The acute form of SLN progresses in one of two types: left and right ventricular failure. With a left-sided lesion, the patient has a high risk of pulmonary edema, and the development of cardiac asthma is not excluded.

Etiology

The development of cardiopulmonary insufficiency occurs against the background of persistent pulmonary hypertension, which at certain stages of the course causes a violation of compensatory mechanisms. As a result, there is a malfunction in the work of the right or left ventricle, dysfunction of pumping venous blood is noted.

The main reasons for the development of a pathological condition are:

1. Cardiac pathologies. Cardiomyopathy, myocarditis, heart defects.
2. Bronchopulmonary diseases. Tuberculosis, bronchitis and chronic bronchiolitis, asthma.

In the first case, such diseases from the side of cardiac pathologies lead to dysfunction of the left ventricle, left ventricular failure develops. With this process, an increase or expansion of the cavity of the left ventricle occurs, intravenous pulmonary pressure increases, the walls of the ventricle cease to eject blood into the bloodstream. In view of these changes, the work of the right ventricle is enhanced, however, and this does not restore full blood supply.

Right ventricular failure develops against the background of pulmonary diseases, accompanied by changes in lung tissue. Even during remission, emphysema is formed in the lungs, the development of which is facilitated by the expansion of healthy tissues.

In such situations, the right ventricle begins to function for wear and tear, the blood is pushed out in an enhanced mode, which causes the development of cardiopulmonary insufficiency.

Causes of acute form of cardiopulmonary insufficiency

The acute form of cardiopulmonary insufficiency is a complication that develops against the background of:

• thrombosis;
• spasm of the pulmonary artery;
• hydro- or pneumothorax;
• thromboembolism;
• bronchial asthma (with a prolonged attack);
• inflammatory process in the lung tissue;
• mitral valve insufficiency;
• mediastinal emphysema;
• various heart diseases: myocarditis, heart defects, cardiomyopathy, acute heart attack;
• mechanical injuries of the chest.

The acute form of pathology is a serious condition requiring emergency medical care. Without a qualified provision of it, the patient is in danger of death.

As a result of the above diseases, the cavity of the left ventricle expands, the contractility of the walls weakens, which makes it impossible to pump blood normally. Part of the blood stagnates and thus increases the pressure in the pulmonary artery.

At the same time, the right ventricle continues to function in the same mode, pumping blood normally, the pressure continues to grow. As a result, such severe consequences as cardiac asthma and pulmonary edema develop.

Causes of chronic cardiopulmonary insufficiency

The chronic form, in contrast to the acute form, develops slowly, gradually increasing and more and more manifesting itself clinically. The increase in pathology occurs over several months or years.

The causes of pulmonary hypertension are:

• idiopathic hypertension of a hereditary nature;
• pulmonary artery insufficiency provoked by endarteritis or secondary embolism of small branches;
• atherosclerosis;
• chronic pathological processes in the lungs: pleurisy, emphysema, obstructive bronchitis, pneumosclerosis;
• slowly developing congenital heart defects;
• acquired valvular dysfunction.

The chronic form is usually diagnosed in elderly patients. Against the background of concomitant disorders present in the body, cardiopulmonary insufficiency gradually but surely begins to develop, which is clinically activated after a few years.

Variants of the course of cardiopulmonary insufficiency and clinical manifestations

There are several options for the course of the disease process, they are determined depending on the clinical manifestations.

Table number 5. Options for the course of cardiopulmonary insufficiency:

Clinical manifestations of acute SLN

The acute form of SLN is characterized by a sudden and dramatic onset of symptoms. The patient's condition during this period is significantly deteriorating, there is a mortal threat.

With the development of an acute attack of SLN, the patient should be immediately taken to the intensive care unit, where he will be provided with emergency qualified medical care.

Attention. A mortal threat appears against the background of thromboembolism, with the active development of pain shock, as well as with extensive pulmonary edema, which occurs as a complication of the acute form of SLN.

In this case, the clinical picture has sufficiently pronounced signs, which makes it easy to make a diagnosis.

The following symptoms are noted:

• a sharp drop in blood pressure to critical levels (collapse is often diagnosed);
• difficulty breathing with frequent shallow breaths;
• expansion of the veins in the neck;
• blueness of the skin, especially discoloration, is noted on the limbs and around the lips;
• coldness of the upper and lower extremities;
• sticky sweat;
• chest pain;
• shortness of breath, often accompanied by suffocation.

Attention. Without timely assistance, a person can die in a few minutes from the development of extensive pulmonary edema or from suffocation.

First aid in such situations is to provide oxygen to the lungs. If necessary, the patient is given artificial respiration.

In some situations, the cause of an attack may be a blockage by a thrombus in the pulmonary trunk, the presence of which a person may not even be aware of.

Clinical manifestations of the chronic form of SLN

The chronic form of pathology has a mild and slow course. For many years, a person may not suspect that he has a similar problem, and only after a while certain signs begin to appear.

Important. The clinical picture depends on the underlying cause of the pathological condition. Often, patients, feeling the symptoms of cardiopulmonary insufficiency, write them off as a manifestation of their diagnosis, without even thinking about the development of such a complex process, which makes further diagnosis and treatment difficult.

Chronic cardiopulmonary insufficiency can be recognized by the following signs:

• the skin of the limbs and around the lips becomes blue;
• dizziness and nausea;
• frequent heart rate;
• shortness of breath that occurs during physical exertion;
• weakness and fatigue.

The severity of symptoms depends on the stage of the disease. For example, severe shortness of breath with asthma attacks are characteristic of the later stages of the pathology. In this case, all of the above symptoms can be supplemented by signs of concomitant diseases.

Due to the further development of the chronic form of SLN, irreversible processes occur in tissues and organs, leading to a deterioration in the patient's condition. As a result, a severe form of SLN is diagnosed.

Its manifestations will be as follows:

• severe shortness of breath even in the absence of any physical exertion;
• intense pain in the region of the heart;
• a strong expansion of the veins in the neck, is noted when inhaling;
• regularly low blood pressure;
• tachycardia;
• swelling that is not amenable to therapy;
• pain in the right hypochondrium, feeling of heaviness.

When the condition has become severe, patients have a high risk of developing dangerous complications.

It:

• disorders of the brain;
• kidney failure.

Effects

The neglect of the process, as well as the lack of qualified medical care, inevitably leads to the development of serious consequences.

Sequelae of acute SLN

The acute form of cardiopulmonary insufficiency leads to such dangerous consequences as:

• pulmonary edema;
• cardiogenic shock.

Table number 6. Consequences of the acute form of SLN:

With the development of such severe consequences, the patient requires immediate anti-shock therapy. The patient should be taken to the intensive care unit as soon as possible, where he will be provided with qualified emergency medical care.

Sequelae of chronic SLN

The chronic process leads to a severe form of oxygen starvation, to a nutrient crisis, which is accompanied by severe shortness of breath and increased signs of cyanosis (cyanosis of the skin).

Due to a disorder of water-salt and protein metabolism, as well as high pressure in the capillaries and liver dysfunction, an accumulation of fluid appears in the soft tissues and in the body cavity, for example, the pericardium, abdominal and pleural. As a result, ascites is diagnosed, which further aggravates the patient's condition.

Ascites, in turn, leads to:

• liver dysfunction;
• digestive disorders;
• internal bleeding.

Hydrothorax (exit of fluid into the pleural cavity) provokes:

• respiratory failure;
• severe shortness of breath with attacks of suffocation.

Hydropericardium (fluid accumulation in the pericardial sac) leads to:

• pain syndrome in the sternal region;
• difficulty passing food;
• swelling of the upper half of the body;
• vein expansion.

Stagnation of fluid in the body inexorably provokes the failure of all functions and systems of the body.

The most common and dangerous consequences can be:

• pneumosclerosis;
• cardiac cirrhosis;
• liver fibrosis;
• congestive gastritis;
• pancreatitis;
• enteritis;
• sudden weight loss;
• dilated cardiomyopathy;
• mitral and aortic insufficiency;
• arrhythmia;
• tachycardia;
• extrasystole;
• lack of urine output;
• kidney failure;
• asthenia;
• sleep disorder;
• encephalopathy;
• stroke;
• thrombosis of deep vessels of the lower extremities;
• thromboembolism of the pulmonary artery.

Prevention of complications of SLN

Prevention of complications of cardiopulmonary insufficiency is based on early diagnosis and timely treatment of the problem. A complete therapy of concomitant diseases that provoke SLN excludes the likelihood of developing consequences in the form of cardiopulmonary insufficiency.

To strengthen the heart muscle, you should adhere to the following rules:

• stop smoking and drinking alcohol;
• eliminate stressful situations;
• timely treat infectious and bacterial diseases;
• try to take drugs that negatively affect the heart as little as possible (these are non-steroidal anti-inflammatory drugs, hormones, adrenaline);
• exclude junk food from the diet, try not to overeat;
• exercise regularly.

If a history already has such a diagnosis as cardiopulmonary insufficiency, then preventive methods are aimed at slowing down the process of its development.

In such situations, patients should do the following:

• control blood pressure and, if necessary, adjust its indicators in a timely manner;
• timely conduct therapy for heart diseases and other concomitant pathologies;
• restore lipid and carbohydrate balance;
• if indicated, agree to surgery for heart defects and coronary disease.

Diagnostics

Early diagnosis of pathological changes in the body will help to avoid an acute attack of cardiopulmonary insufficiency.

When a patient goes to the hospital, the doctor first of all listens to the patient's complaints, collects an anamnesis, and asks about addictions to bad habits. An important method of examination is listening to the heart, measuring blood pressure. After the examination, the doctor gives a referral for the examination.

Diagnostics includes:

1. X-ray examination of the chest. It makes it possible to determine the presence of changes in the lung tissue and the expansion of the mediastinum.
2. EchoCG. Allows you to determine the dysfunction of the valvular apparatus, to assess the contractility of the myocardium and disturbances in cardiac output.
3. CT. Gives an in-depth assessment of areas of the heart and lungs.
4. ECG. Shows the excitability and conduction of the heart. Based on the results of the ECG, it is possible to identify hypertrophied areas of the myocardium, determine the location of ischemic damage, and establish a violation of the heart rhythm. If a doubtful situation arises, observation with the help of a Holter can be additionally assigned. This device allows for 2 hours a day to take readings at regular intervals.
5. Angiography of the pulmonary vessels. It makes it possible to visually determine the shape and lumen of blood vessels, to identify the presence of blood clots, as well as atherosclerotic changes.
6. Spirometry. This method of instrumental diagnostics shows the severity of respiratory failure.
7. Catheterization with manometer. Measures pressure in the cavity of the heart and large pulmonary vessels. It is used in the treatment of thrombosis: a special drug is injected into the catheter that dissolves the blood clots that have appeared.

In the presence of a diagnosis of heart failure and pulmonary hypertension, these diagnostic methods are carried out even at the preclinical stage, the goal is to exclude and prevent the development of cardiopulmonary insufficiency.

Treatment

Tactics of drug therapy in acute and chronic form is distinctive. The use of drugs depends on the rate and course of SLE.

Treatment of acute SLN

The acute form of SLN requires emergency medical attention. Treatment is carried out only in the intensive care unit, as this condition poses a serious threat to the life of the patient.

Treatment includes:

1. nasal catheterization. Allows the patient to receive the necessary amount of oxygen. In severe situations, a decision is made to artificially ventilate the lungs.
2. Intra-arterial catheterization. It is carried out in order to dissolve the blood clots in the pulmonary arteries.
3. Atropine treatment. Atropine allows you to relieve spasms of the bronchial walls and normalize the respiratory rhythm.
4. Treatment with papaverine. Allows you to remove hypertension in the pulmonary circulation, normalize the tone of blood vessels.
5. Treatment with anticoagulants. This group of drugs is aimed at preventing the formation of blood clots in the heart cavity and blood vessels.
6. Eufillin treatment. This drug normalizes the contractility of the heart muscle, and also minimizes the risks of developing respiratory failure.

Attention. If signs of acute cardiopulmonary failure appear, act quickly. It is immediately necessary to call an ambulance team and provide the patient with first aid, which consists in maximizing the access of oxygen to the body. If necessary, artificial respiration is done.

Treatment of chronic SLN

In this situation, treatment is aimed at eliminating the underlying cause of the pathological condition.

Treatment includes:

1. Bronchodilators. They are prescribed in the presence of bronchopulmonary diseases.
2. Hormonal preparations. Glucocorticosteroids are prescribed as anti-inflammatory therapy.
3. cardiac glycosides. They are used to restore the lost contractility of the heart muscle.
4. Potassium-sparing diuretic drugs. Allow to eliminate the risk of congestion, remove excess fluid from the body.
5. Beta blockers. They are used to normalize blood pressure.
6. camphor and caffeine. Used for respiratory failure, drugs are able to stimulate the vasomotor center.
7. Bloodletting with replacement of blood with special solutions. This method is used for severe erythrocytosis.

Advice. As a preventive measure for the development of severe consequences and further suppression of cardiopulmonary insufficiency, patients should categorically exclude bad habits and alcohol consumption.

Emergency care for an acute attack of cardiopulmonary insufficiency

Since the acute form of SLN is dangerous with the sudden onset of severe attacks, accompanied by respiratory arrest, a significant failure of the heart rhythm, up to cardiac arrest, relatives and close friends of such patients must know the rules for providing emergency care in such situations.

Before the arrival of the ambulance, you must perform the following actions:

1. Ensure the patient is in a sitting position.
2. If possible, take the patient outside, or open all windows and doors, try to provide him with oxygen access as much as possible.
3. To reduce high blood pressure, you need to give a Nitroglycerin tablet, which is placed under the tongue and dissolves.
4. In the presence of excessively high pressure, attempts should be made to remove excess fluid from the lungs. For this purpose, heated water is poured into the basin and the patient must lower his legs into it.
5. To reduce acute symptomatic manifestations, moisten a cotton swab in alcohol and give the victim a sniff.

An inexperienced person, ignorant of the rules for providing emergency care, may not help the victim, but, on the contrary, harm him. Therefore, if there is uncertainty in your actions, it is better to call the ambulance phone and ask in detail about the actions that can be performed before the doctors arrive.

Treatment of SLN with folk methods

It should immediately be noted that treatment with alternative methods gives a positive result only in combination with drug therapy. At the same time, it must be remembered that acute SLN is not amenable to treatment with traditional medicine, in such cases, such treatment can have an effect as a restorative therapy.

There are many recipes that allow you to restore, strengthen and stimulate the heart muscle and prevent the development of consequences in the form of pulmonary insufficiency and pulmonary edema.

Table number 7. Recipes of traditional medicine in the fight against heart failure.

All of the above traditional medicine recipes are aimed at strengthening and stimulating the heart. By restoring the normal functioning of the heart muscle, you can reduce the risks of developing further pathologies and their consequences.

In addition, proper fortified nutrition is important in the fight against such a problem. It is recommended to use only natural products, fresh fruits and vegetables, juices, milk and dairy products.

Foods that have a very beneficial effect on the heart are:

• walnuts;
• raisin;
• dried apricots;
• millet;
• watermelon.

• strong tea;
• coffee;
• chocolate;
• spices;
• fried, smoked, salty and spicy dishes.

Such a breakfast is considered an excellent means of preventing heart failure: a large clove of garlic is crushed and spread on brown bread, you can add a little salt. Very tasty and healthy!

To eliminate the risk of developing acute attacks of SLN, you should regularly undergo preventive examinations, and if any violations are detected, they should be treated in a timely manner. The prognosis for acute SLN depends on the quality and timeliness of the first aid provided. With a positive outcome, the patient needs a long and labor-intensive rehabilitation and compliance with the important recommendations of the attending physician.

The video in this article will introduce the risks of consequences in cardiopulmonary failure.